Provider Demographics
NPI:1134248412
Name:WEST COUNTY PULMONARY ASSOCIATES
Entity type:Organization
Organization Name:WEST COUNTY PULMONARY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:E
Authorized Official - Last Name:FLURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-822-3122
Mailing Address - Street 1:505 COUCH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5568
Mailing Address - Country:US
Mailing Address - Phone:314-822-3122
Mailing Address - Fax:314-821-7362
Practice Address - Street 1:505 COUCH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-5568
Practice Address - Country:US
Practice Address - Phone:314-822-3122
Practice Address - Fax:314-821-7362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP4225Medicare ID - Type UnspecifiedRR MCR GROUP ID
IL209782Medicare ID - Type UnspecifiedILLINOIS MCR GROUP ID